Return to Scenario ListShow Learning Points most relevant to Phase 1:

Patient with jaundice

Clinical Discipline(s)/Organ System(s)
Digestive System, General Surgery, Gastroenterology & Hepatology
Progress Test Topic(s)
A 67 year old Cook Island Māori man presents to his GP after his wife commented that he had 'gone yellow'. He has recently been feeling fatigued and suffers from bouts of abdominal pain, especially after eating. The GP asks if you can take a history before they see the patient. You speak to him and he tells you that his stool is pale and his urine is dark.
Progress Test-Type Questions:   Question 1 | Question 2 | Question 3
Applied Science for Medicine 
   - Anatomy of the liver and its functions; include microscopic detail of lobules and the relationship between the portal and hepatic blood supplies and the bile ductules
   - Anatomy and function of the biliary tree and pancreas
   - Pathophysiology of portal hypertension
   - Production and excretion of bilirubin
   - Types of gallstones
   - Pharmacology of penicillins, fluoroquinolones, macrolides, extended spectrum penicillins and aminoglycosides
   - How vaccinations induce an immune response
Personal and Professional Skills 
Deliver life-changing news
   - Empathise with a patient with cancer
   - Communicate with patient and family/whanau in relation to death and dying
Hauora Māori 
   - Cater for differential health literacy needs of Māori patients and whānau
   - Awareness of differing risk profiles for Māori (and other disadvantaged populations) compared with non-Māori in New Zealand in presentations of jaundice (e.g. hepatitis, cancer)
   - Understanding of inequities in health outcomes for Māori compared with non-Māori including liver cancer rates 4 times higher in Māori than non-Māori, and application of this to clinical decision making and management
   - Consideration of access to cultural/spiritual support for patient and whānau
   - Understanding of the role of kaupapa Māori cancer and health policies, services and research in reducing inequalities
Population Health 
   - Epidemiology of pancreatic cancer and gallstones
Conditions to be considered relating to this scenario
gallstones, drug-induced liver disease, cholecystitis, pancreatic adenocarcinoma, external compression of bile duct, liver metastases
Less common but 'important not to miss'
hepatocellular carcinoma, primary biliary cirrhosis, cholangiocarcinoma, liver abscess
amyloidosis, haemochromatosis